The use and misuse of ratio and proportion exposure measures in food environment research
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The use and misuse of ratio and proportion exposure measures in food environment research Lukar E. Thornton1* , Karen E. Lamb2 and Simon R. White3
Abstract Background: The food stores within residential environments are increasingly investigated as a possible mechanism driving food behaviours and health outcomes. Whilst increased emphasis is being placed on the type of study designs used and how we measure the outcomes, surprisingly little attention gets diverted to the measures of the food environment beyond calls for standardised approaches for food store coding and geographic scales of exposure. Food environments are a challenging concept to measure and model and the use of ratio and proportion measures are becoming more common in food environment research. Whilst these are seemingly an advance on single store type indicators, such as simply counting the number of supermarkets or fast food restaurants present, they have several limitations that do not appear to have been fully considered. Main body: In this article we report on five issues related to the use of ratio and proportion food environment measures: 1) binary categorisation of food stores; 2) whether they truly reflect a more or less healthy food environment; 3) issues with these measures not reflecting the quantity of food stores; 4) difficulties when no stores are present; and 5) complications in statistical treatment and interpretation of ratio and proportion measures. Each of these issues are underappreciated in the literature to date and highlight that ratio and proportion measures need to be treated with caution. Conclusion: Calls for the broader adoption of relative food environment measures may be misguided. Whilst we should continue to search for better ways to represent the complexity of food environments, ratio and proportion measures are unlikely to be the answer. Keywords: Food environment, Built environment, Neighbourhood, Dietary behaviours, Obesity
Background Over the last 20 years, researchers investigating the role of neighbourhood food environments on food behaviours and health outcomes have used an increasing number of different and, in appearance, more sophisticated measures to capture exposure to the food environment [1–7]. As an example, food environment exposure measures have shifted from linking exposure data at an administrative unit level * Correspondence: [email protected] 1 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia Full list of author information is available at the end of the article
(e.g., fast food restaurants within a postcode [8]), to GIS measures created around individual households (e.g., fast food restaurants within a buffer [9–11]), and more recently to capturing exposure within activity spaces (e.g., fast food restaurants within the daily paths travelled by an individual [12]). As debated elsewhere, there is no clear consensus on the most appropriate exposure measures and consequently this
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